Why Does My Hip Hurt When I Lie On My Side? Understanding Lateral Hip Pain

You finally get into bed after a long day, roll onto your favourite side and almost immediately feel an ache on the outside of your hip.

You try adjusting your position, moving your leg or rolling onto the other side. Sometimes that helps. Other nights, you find yourself constantly changing positions because neither hip feels particularly comfortable.

Perhaps the pain is not limited to bedtime. You might notice it when walking uphill, climbing stairs, standing on one leg to put your pants on or getting out of the car after a long drive.

If this sounds familiar, you may be experiencing lateral hip pain, which simply means pain around the outside of the hip.

One possible cause is a condition known as greater trochanteric pain syndrome, or GTPS. This commonly involves the gluteal tendons and surrounding soft tissues, although not every person with pain on the outside of their hip has the same condition.

The important thing to understand is that lateral hip pain is not always a problem that needs more stretching, more massage or complete rest.

For many people, the longer-term solution involves understanding what is irritating the hip, temporarily adjusting the activities or positions that aggravate it, and progressively rebuilding the strength and load tolerance of the surrounding muscles and tendons.

Where Exactly Is Lateral Hip Pain?

Lateral hip pain is felt around the outside of the hip, often over the prominent bony area near the top of the thigh.

You may notice tenderness when pressing directly over this area, particularly if you lie on

that side in bed.

Some people describe a relatively localised ache, while others experience discomfort extending down the outside of the thigh.

The location of your pain can provide useful information, but it does not establish a diagnosis on its own.

Pain around the hip can originate from several different structures, and symptoms can overlap.

For example, pain felt predominantly in the groin may be associated with a different presentation from pain directly over the outside of the hip. Symptoms travelling from the lower back into the buttock or leg may also require a different assessment.

This is why a Physiotherapy assessment considers more than simply where you point when asked, “Where does it hurt?”

What Is Greater Trochanteric Pain Syndrome?

Greater trochanteric pain syndrome, commonly shortened to GTPS, is an umbrella term used to describe pain arising from structures around the outside of the hip.

The greater trochanter is the bony prominence at the top of your thigh bone.

Several important structures are located around this area, including the tendons of the gluteus medius and gluteus minimus muscles and small fluid-filled sacs known as bursae.

The gluteal muscles help control and produce movement at the hip, particularly when you are standing or moving on one leg.

Their tendons attach to the upper portion of the thigh bone and transmit force between the muscles and bone.

When these structures become sensitive, activities that place pressure or load through the outside of the hip may become uncomfortable.

GTPS is commonly associated with pain during side lying, stair climbing, walking and standing on one leg. However, those symptoms can occur with other conditions too, so an individual assessment is important.

Is Lateral Hip Pain The Same As Hip Bursitis?

You may have heard the term “trochanteric bursitis”.

Historically, pain around the outside of the hip was often attributed to inflammation of the bursa.

A bursa is a small fluid-filled sac that helps reduce friction between neighbouring tissues.

Bursae can become irritated, but lateral hip pain is not always caused by an inflamed bursa.

The gluteal tendons are frequently involved, which is why clinicians may use terms such as gluteal tendinopathy or greater trochanteric pain syndrome.

This distinction matters because treating every case as a simple inflammatory problem may overlook the role of strength, tendon loading and activity tolerance.

What Is Gluteal Tendinopathy?

Gluteal tendinopathy refers to a painful condition involving one or more of the gluteal tendons, commonly the gluteus medius or gluteus minimus tendon.

Tendons are strong connective tissues that transmit force from muscles to bones.

They are designed to tolerate load.

In fact, appropriate loading is important for maintaining tendon capacity.

Problems can develop when the demands placed on a tendon exceed what it can currently tolerate.

That does not necessarily mean the tendon has torn or that exercise is damaging it.

A tendon may become painful following a change in activity, a period of reduced conditioning or repeated exposure to positions and loads that it is not currently tolerating well.

The goal of rehabilitation is generally not to protect the tendon from every possible force.

It is to help it tolerate the forces required for your everyday activities again.

Why Does My Hip Hurt More When I Lie On My Side?

Side sleeping can place direct pressure through the tissues around the outside of the hip.

If those tissues are already sensitive, that pressure may become uncomfortable.

There are two common situations worth considering.

1. Lying Directly On The Painful Hip

When you lie on the affected side, your body weight creates direct pressure over the outer hip.

If this area is sensitive, the pressure may provoke pain even when you are otherwise resting.

This is why some people can walk relatively comfortably during the day but struggle to sleep on their preferred side.

2. Lying On The Opposite Side Without Supporting The Top Leg

This can be less obvious.

Imagine that your right hip is painful, so you roll onto your left side.

Your right leg drops forward and across your body.

That position brings the right hip into adduction, meaning the leg moves towards or across the body's midline.

For some people with gluteal tendon-related pain, this position can increase compression around the outside of the upper hip.

As a result, even sleeping on the opposite side may be uncomfortable.

This is one reason a pillow between the knees and thighs can be useful.

It helps support the top leg rather than allowing it to fall across the body.

What Is The Best Sleeping Position For Outer Hip Pain?

There is no single sleeping position that works for everyone, but a few adjustments may reduce irritation.

If you prefer sleeping on your back: Try placing a pillow underneath your knees if this feels comfortable. This can help you settle into a supported position without direct pressure on either outer hip.

If you prefer sleeping on your side: Try lying on the less painful side with a sufficiently thick pillow between your knees and thighs. The aim is to support the top leg so it does not drop across your body.

If both hips are painful: Back sleeping may be more comfortable temporarily, although your individual symptoms and other conditions will influence what works.

You do not need to spend the entire night consciously maintaining a perfect position.

The goal is simply to reduce unnecessary irritation so you can sleep more comfortably while working on the underlying problem.

Why Does My Hip Hurt When I Walk?

Walking places repeated load through the hip muscles and tendons.

Every time you take a step, you briefly support your body weight on one leg.

The gluteal muscles help manage the position of your pelvis and hip during this phase.

If the tissues around the outside of your hip are sensitive, repeated single-leg loading may provoke symptoms.

You might notice that a short walk feels comfortable but pain develops as the distance increases.

Or perhaps you can walk on flat ground without much difficulty but experience discomfort on hills or stairs.

This can be a sign that your current walking demands are exceeding what the hip comfortably tolerates.

It does not automatically mean walking is harmful.

It means the amount and type of walking may need to be adjusted while you rebuild capacity.

Why Is Walking Uphill Often More Painful?

Walking uphill changes the demands placed on the lower body.

The hip and knee need to work through different joint positions, and the muscles may need to produce more force than they do during comfortable flat-ground walking.

For someone with lateral hip pain, this additional demand can be enough to provoke symptoms.

A person may therefore tolerate a 30-minute flat walk but struggle with a much shorter walk involving steep hills.

When planning rehabilitation, it is useful to consider not just how far someone walks but also the terrain, speed and cumulative activity across the day.

Why Does My Hip Hurt When I Climb Stairs?

Stair climbing involves repeated single-leg loading and greater demands on the muscles around the hip.

If you are already experiencing lateral hip pain, this can make stairs uncomfortable.

Some people notice pain when pushing up onto the next step, while others experience discomfort when controlling the descent.

The response can vary depending on strength, movement strategy, step height and current symptom sensitivity.

A rehabilitation programme may therefore begin with a lower step, additional support or a reduced number of repetitions before progressing towards normal stair climbing.

The aim is not to avoid stairs forever.

It is to build the capacity required to use them comfortably.

Why Does Standing On One Leg Hurt?

Standing on one leg places a substantial demand on the muscles responsible for controlling the pelvis and hip.

This is why activities such as putting on pants, standing while brushing your teeth or balancing on one leg during exercise may provoke symptoms.

You may also notice that standing with most of your weight shifted onto one hip becomes uncomfortable.

If your lateral hip is particularly irritable, temporarily distributing your weight more evenly or sitting down to get dressed may help reduce repeated aggravation.

These are short-term modifications, not permanent movement rules.

As your hip becomes stronger and symptoms settle, you can progressively return to more demanding single-leg activities.

Why Does My Hip Hurt After Sitting?

Some people experience discomfort around the outside of the hip after prolonged sitting, particularly in low chairs or car seats.

Sitting can place the hip in a sustained position, and certain seats may create direct pressure around the outer hip.

When you stand up, the first few steps may feel uncomfortable before movement becomes easier.

However, pain after sitting is not specific to gluteal tendinopathy.

Hip joint conditions, lumbar spine problems and other causes may produce similar symptoms.

If your pain is persistent or you are unsure where it is coming from, assessment can help identify the relevant contributing factors.

Why Does My Hip Hurt When I Cross My Legs?

Crossing your legs places the upper hip into an adducted position.

For some people with gluteal tendon-related pain, this can increase compression around the outside of the hip.

If you find yourself repeatedly crossing your legs at work or sitting with one knee dropped across the other, temporarily changing that position may help.

You do not need to become afraid of crossing your legs.

The aim is to reduce repeated exposure to a position that is currently aggravating symptoms.

Once your hip is less sensitive and your load tolerance improves, you may find that positions which were previously uncomfortable become easier again.

Is Outer Hip Pain Caused By Weak Glutes?

Gluteal strength can be an important part of the picture, but it is not the only possible contributor.

The muscles around the hip help manage load during walking, stairs, running and single-leg tasks.

If your current strength or endurance is insufficient for the demands you place on the hip, the surrounding tissues may become more sensitive.

However, pain does not automatically prove that your glutes are weak.

A person can have relatively strong glutes and still experience lateral hip pain after a sudden increase in running volume, repeated hill walking or another change in activity.

A good assessment looks at the relationship between your current capacity and your actual demands, rather than assuming everyone with hip pain needs the same glute exercises.

Can Too Much Walking Cause Gluteal Tendinopathy?

A sudden increase in walking can contribute to lateral hip symptoms in some people.

For example, imagine that you usually walk 20 minutes on relatively flat ground a few times per week.

You then go on holiday and begin walking for several hours every day, including hills and stairs.

Your overall activity level has changed significantly.

If your hip is not currently conditioned for that amount of repeated loading, symptoms may develop.

This does not mean walking is bad for your hips.

It means your body may need time to adapt to a higher workload.

The same principle applies to running, hiking, exercise classes and other activities that increase the demand on your lower body.

Should I Stop Walking If My Hip Hurts?

Not automatically.

Complete rest is not always necessary or helpful for lateral hip pain.

For many people, maintaining an appropriate level of activity while temporarily reducing aggravating demands is a more practical approach.

You might begin by adjusting:

• Walking distance or duration.

• Hill and stair exposure.

• Walking speed.

• The number of longer walks performed each week.

• Recovery time between more demanding sessions.

For example, if a 60-minute walk consistently aggravates your hip that evening and the following morning, you may temporarily reduce the distance and reassess your response.

The goal is to find an amount of walking that you can tolerate reasonably well, then gradually build from there.

If walking causes marked pain, a limp, progressively worsening symptoms or difficulty bearing weight, seek an appropriate assessment rather than simply pushing through.

How Do I Know If I Am Doing Too Much?

One of the most useful things you can do is pay attention to how your hip responds after activity.

Do not judge the exercise only by how it feels during the session.

Consider what happens:

• Later that evening.

• When you lie on your side that night.

• During your first steps the following morning.

• During your usual walking or stair climbing the next day.

Some discomfort during rehabilitation may be acceptable for certain presentations, but the appropriate level is individual.

If a particular exercise repeatedly produces a substantial increase in symptoms or disrupts your sleep, the current dose may be too high.

You may need to change the resistance, range, repetitions, exercise choice or recovery time.

A Physiotherapist can help you establish an appropriate starting point and progression rather than relying on a universal pain-number rule.

Should I Stretch My Hip If It Feels Tight?

This is where lateral hip pain can become confusing.

You feel tight around the outside of your hip, so naturally you want to stretch it.

Perhaps you perform a figure-four stretch, pull your knee across your body or use a foam roller directly over the painful area.

Sometimes that provides temporary relief.

Other times, your hip feels significantly worse afterwards.

If your symptoms are associated with gluteal tendon irritation, certain stretches that bring the hip across the body's midline may increase compression around the painful area.

This does not mean stretching is inherently bad.

It means the right intervention depends on the structure involved and the direction of loading.

If aggressive stretching repeatedly aggravates your outer hip, continuing to stretch harder is unlikely to be the best solution.

Why Foam Rolling The Outside Of My Hip May Make It Worse

Foam rolling is often recommended for anything that feels tight.

However, placing significant pressure directly over a sensitive outer hip can reproduce the very compression that aggravates your symptoms.

If you notice that rolling directly over the painful bony area causes a substantial flare-up, it may be worth avoiding that technique temporarily.

There is no requirement to forcefully massage a painful tendon in order for it to recover.

A treatment can feel intense without necessarily being useful.

Is My IT Band Too Tight?

The iliotibial band, commonly called the IT band, is a strong band of connective tissue running along the outside of the thigh.

It is frequently blamed for lateral hip pain.

However, the sensation of tightness around the outside of the thigh does not necessarily mean the IT band itself needs to be stretched or released.

If the gluteal tendons are sensitive, aggressive stretching or compression around the outer hip may aggravate symptoms.

Rather than assuming the IT band is the problem, assessment should consider the hip muscles, tendons, joint, lumbar spine and the activities that reproduce your pain.

Can Menopause Contribute To Lateral Hip Pain?

Lateral hip pain and gluteal tendinopathy are commonly seen in middle-aged women, including during the perimenopausal and postmenopausal years.

Hormonal changes may be one contributing factor, although the relationship is complex and menopause is not a diagnosis or an inevitable cause of hip pain.

Changes in strength, activity, recovery and overall tendon loading can also be relevant.

The important message is that women experiencing hip pain during midlife should not simply be told that it is something they have to accept because they are getting older.

Appropriate assessment and progressive rehabilitation can still be valuable.

Can Lateral Hip Pain Come From My Lower Back?

Yes.

Pain felt around the outer hip does not always originate from the gluteal tendons.

The lumbar spine can sometimes produce referred pain into the buttock, hip or thigh.

Some people may also experience nerve-related symptoms such as tingling, numbness or altered sensation.

Other conditions involving the hip joint can produce symptoms that overlap with lateral hip pain.

This is one reason we do not recommend diagnosing yourself with bursitis or tendinopathy based solely on where the pain is located.

A Physiotherapist can assess your hip and lumbar spine, review your symptom behaviour and determine whether further investigation or medical review is appropriate.

How Is Lateral Hip Pain Diagnosed?

A Physiotherapy assessment generally begins with a detailed discussion about your symptoms.

We want to understand:

• Where the pain is located.

• When it started.

• Whether there was an injury or change in activity.

• Which sleeping positions aggravate it.

• How it responds to walking, stairs and standing.

• Whether you experience back pain or symptoms travelling down the leg.

• How it affects your daily activities and exercise.

• What you have already tried.

The physical assessment may then include hip movement, strength testing, functional movements and examination of the surrounding regions.

The aim is to identify the most likely source of symptoms and the factors that are relevant to your rehabilitation.

Do I Need An MRI Or Ultrasound?

Not everyone with lateral hip pain needs imaging.

In many cases, the combination of symptom history and physical assessment provides enough information to guide initial management.

Imaging may be considered when the diagnosis is uncertain, symptoms are atypical, there has been significant trauma or recovery is not progressing as expected.

It is also important to understand that scans can show tendon changes in people who do not have pain.

An imaging finding needs to be interpreted alongside your symptoms and clinical examination.

A scan should not replace an assessment of the person.

What Is The Best Treatment For Lateral Hip Pain?

There is no single treatment that is appropriate for every cause of lateral hip pain.

For gluteal tendon-related presentations, management commonly involves a combination of:

1. Understanding the condition. Knowing why particular positions and activities aggravate your symptoms can help you make useful adjustments without becoming afraid of movement.

2. Temporarily reducing aggravating compression. This may involve modifying side sleeping, prolonged hip-hanging positions or certain stretches while the area is particularly sensitive.

3. Managing your current activity load. Walking, stairs, running and exercise may need to be adjusted rather than stopped completely.

4. Progressive strengthening. The hip muscles and tendons need to develop the capacity required for your everyday activities.

5. Gradually returning to your goals. Rehabilitation should eventually prepare you for the activities you want to perform, whether that is walking comfortably, returning to Pilates, hiking or running.

Why Strengthening Is Important

The gluteal muscles help control the pelvis and produce force during everyday movement.

If you want to tolerate longer walks, stairs, running or single-leg exercise, those muscles need sufficient strength and endurance for the task.

Strengthening can be introduced at an appropriate level and progressively increased as symptoms and capacity improve.

The goal is not simply to make the hip burn.

It is to build useful strength that transfers into your daily life.

What Exercises Can Help Lateral Hip Pain?

The most appropriate exercises depend on the cause and irritability of your symptoms.

For someone with gluteal tendon-related pain, a rehabilitation programme may include selected variations of:

• Supported standing hip abduction.

• Isometric hip abduction.

• Bridges.

• Sit-to-stands.

• Squats.

• Step-ups.

• Supported single-leg exercises.

• Progressive lower-body resistance training.

These are examples of exercises that may be used during rehabilitation, not a universal programme for everyone with hip pain.

The starting position, resistance, range and volume all matter.

An exercise that is useful later in rehabilitation may be too provocative during an irritable phase.

Why Side-Lying Glute Exercises Are Not Always The Best Starting Point

This is particularly relevant for Pilates clients.

Side-lying leg lifts, clams and other lateral hip exercises are often prescribed automatically when someone reports outer hip pain.

But if lying on the affected hip is already painful, placing that hip directly against the mat may be uncomfortable.

Certain side-lying positions can also increase compression around the upper hip.

That does not mean clams or side-lying leg lifts are bad exercises.

It means they are not automatically the right starting point for every person with lateral hip pain.

A supported standing exercise, an isometric variation or another position may be more appropriate initially.

Exercise selection should reflect the person's symptoms rather than simply targeting the muscle we think needs strengthening.

Can Clinical Pilates Help With Lateral Hip Pain?

Clinical Pilates can provide a useful environment for progressively rebuilding hip strength, movement tolerance and confidence.

At Body Form, we can use Pilates equipment to modify:

• Resistance.

• Range of movement.

• Body position.

• Support.

• Balance demands.

• Single-leg loading.

This allows us to find exercises that match your current capacity and then progressively increase the challenge.

For example, someone who cannot comfortably tolerate prolonged single-leg standing may initially benefit from a more supported exercise.

As their strength and symptoms improve, the programme can progress towards standing and functional movements that better reflect everyday life.

Clinical Pilates should not simply be about avoiding every uncomfortable movement.

The longer-term goal is to help you return to those movements with greater capacity.

Is Reformer Pilates Good For Hip Pain?

Reformer Pilates can be useful, but the equipment does not automatically make every exercise appropriate.

Different spring settings, positions and movement patterns place different demands on the hip.

For example, a supported Reformer exercise may be relatively comfortable for someone who struggles with standing work.

However, some standing or side-lying Reformer exercises may place considerable load through the outer hip.

The spring resistance can also provide assistance in one direction and resistance in another.

This is why exercise selection and spring settings should be based on the individual rather than assuming that lighter springs or a particular exercise name automatically makes a movement suitable for rehabilitation.

Should I Avoid Single-Leg Exercises?

Not forever.

Single-leg loading is a normal part of walking, stair climbing and many everyday activities.

If standing on one leg is currently painful, you may need to temporarily reduce the demand.

That could involve:

• Holding onto support.

• Reducing the duration.

• Using a smaller range.

• Changing the resistance.

• Choosing a bilateral exercise initially.

As your capacity improves, single-leg work can be progressively reintroduced.

The goal is to become more capable of managing normal movement, not permanently avoid it.

How Long Does Lateral Hip Pain Take To Improve?

Recovery varies considerably.

Some people improve relatively quickly when aggravating activities are modified and appropriate strengthening begins.

Others experience symptoms for longer, particularly if the problem has been present for months, sleep is significantly disrupted or the hip is repeatedly exposed to loads it

cannot yet tolerate.

Tendon rehabilitation is often a gradual process.

It is important to look for progress in more than one area.

For example, you may notice that you can walk further, tolerate stairs more comfortably or sleep for longer before you experience a substantial reduction in every symptom.

These changes are meaningful signs of improving function.

If you are not making progress, your diagnosis and rehabilitation programme should be reviewed rather than simply repeating the same exercises indefinitely.

When Should I See A Physiotherapist?

Consider booking a Physiotherapy assessment if:

• You regularly wake because of hip pain.

• You cannot comfortably lie on either side.

• Pain is affecting walking, stairs or everyday activities.

• Symptoms have persisted despite modifying activity.

• You are repeatedly experiencing flare-ups after exercise.

• You are unsure whether the pain is coming from your hip or lower back.

• You are avoiding exercise because you do not know what is safe.

• Your symptoms are progressively worsening.

A Physiotherapist can help determine what is contributing and develop a programme that matches your current capacity and goals.

When Is Hip Pain More Urgent?

Seek prompt medical assessment if you experience severe hip pain after a fall or other injury, cannot bear weight, or develop a hot, swollen hip with fever or significant illness.

New or progressive leg weakness, substantial numbness or other concerning neurological symptoms also warrant medical assessment.

Persistent, unexplained or progressively worsening pain, particularly when accompanied by systemic symptoms, should not simply be assumed to be tendinopathy.

Stop Stretching The Pain And Start Understanding It

If the outside of your hip hurts every time you lie on your side, the answer may not be another glute stretch or a harder session with the foam roller.

For some people, the painful tissues need a temporary reduction in aggravating pressure and a more appropriate amount of loading.

Then, as symptoms settle, they need to become stronger.

The goal is not to avoid lying on your side, climbing stairs or walking uphill forever.

It is to build the capacity to do those things comfortably again.

Physiotherapy And Clinical Pilates For Hip Pain At Body Form Mona Vale

At Body Form Physiotherapy & Clinical Pilates, we take an individualised approach to hip pain.

Rather than assuming that every painful outer hip is bursitis or that every client simply needs stronger glutes, we assess your symptoms, movement, strength, activity demands and goals.

Depending on your presentation, your rehabilitation may involve Physiotherapy, temporary activity modifications, progressive strength training and Clinical Pilates using equipment such as the Reformer, Trapeze Table and Wunda Chair.

Our small-group Clinical Pilates classes are capped at six clients, allowing our instructors to provide individual guidance and appropriate exercise modifications. We also offer private and semi-private sessions for clients who need more individualised support.

Whether your goal is to sleep comfortably, return to walking, manage stairs or get back to your usual Pilates and strength training, we want your rehabilitation to prepare you for the activities that matter to you.

If outer hip pain is regularly disrupting your sleep or limiting your exercise, book a Physiotherapy assessment with Body Form Mona Vale on Sydney's Northern Beaches.

The first step is understanding what is actually contributing to your pain. From there, we can build a plan to help you move with greater comfort and confidence.